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Dapagliflozin again shows kidney, cardiovascular benefit beyond glucose control

New England Journal of Medicine
Reuters Health - 24/09/2020 - The diabetes drug dapagliflozin can prevent decline in kidney function among patients with chronic kidney disease, according to new results from the DAPA-CKD trial.

Researchers following 4,304 volunteers for a median of 2.4 years saw kidney function decline in 9.2% of dapagliflozin recipients compared with 14.5% of placebo recipients, a reduction of 39% (P<0.001).

"Decline" was defined as a drop of at least 50% in estimated glomerular filtration rate (eGFR), end-stage kidney disease, or death from renal or cardiovascular causes.

When cardiovascular deaths were taken out of the mix, the drug lowered the combined risk by 44% (P<0.001) compared with placebo.

"The effects of dapagliflozin were similar in participants with type 2 diabetes and in those without," said the team, led by Hiddo Heerspink of the University of Groningen in the Netherlands.

The study, published in The New England Journal of Medicine and presented at the annual meeting of the European Association for the Study of Diabetes, is only the latest to suggest that sodium-glucose cotransporter 2 (SGLT2) inhibitors such as dapagliflozin have benefits far beyond their glucose-lowering abilities.

Astra-Zeneca, which sells the drug under the brand name Farxiga, paid for the study.

Inclusion criteria included a GFR between 25 and 75 ml/min/1.73m2 and a urinary albumin-to-creatinine ratio of 200 to 5,000. One third of the patients did not have diabetes.

When the researchers lumped together hospitalization for heart failure and death from cardiovascular causes, dapagliflozin therapy produced a risk that was 29% lower, with a rate of about 6% versus nearly 8% for placebo therapy (P=0.009).

The death rate was 4.7% with the drug and 6.8% without (P=0.004).

"Our trial confirms that the kidney-protective effects of SGLT2 inhibitors extend to the broader population of persons with chronic kidney disease without type 2 diabetes, for whom ACE inhibitors are the only pharmacologic treatments that have been shown to prevent kidney failure," the Heerspink team said.

By Reuters Staff

SOURCE: https://bit.ly/33T8RKW The New England Journal of Medicine, online September 24, 2020.

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